Kakodkar Pramath, Shekari Nooshin, Thipse Madhura, Datta Debajyoti, Tu Albert
Diagnostic and Clinical Pathology, University of Saskatchewan, Saskatoon, SK, Canada.
Department of Anatomy, Physiology & Pharmacology, University of Saskatchewan, Saskatoon, SK, Canada.
Adv Tech Stand Neurosurg. 2025;51:65-80. doi: 10.1007/978-3-031-86441-4_6.
Selective dorsal rhizotomy (SDR) has been instrumental in improving functionality and mitigating lower extremity spasticity originating from a myriad of central nervous system (CNS) etiologies. Existing literature on SDR extensively discusses its utility in cerebral palsy (CP)-associated spasticity management. There is a void on the utility and guidance in patient selection for SDR in pediatric patients with non-CP-related spasticity.
A systematic review was performed on studies describing SDR outcomes in pediatric patients identified from Medline and Embase databases. Publications between January 1970 and August 2023 were included. Combinations of search terms "selective dorsal rhizotomy," "selective posterior rhizotomy," and "spasticity" were utilized. Pediatric patient studies with clinical data on spasticity, ambulation, procedural variables, and follow-up outcomes were included. Articles including patients without cerebral palsy as a primary diagnosis were reviewed in detail for outcomes after intervention.
A total of 114 publications were identified, and of these, 11 fit inclusion criteria for a total of 127 patients. Most common non-CP etiologies for spasticity included hereditary spastic paraparesis (27.8%, n = 34), congenital syndrome (n = 7), and spinal cord injury (21.9%, n = 6). Compared to their baseline, SDR in non-CP-related etiologies demonstrated tone normalization (93%, n = 43 out of 45 patients) in most and improvement in ambulation (49.2%, n = 58 out of 118 patients) in a significant proportion of patients.
This systematic review on SDR in pediatric patients revealed effective spasticity control and improvement in ambulatory functionality in selected patients without cerebral palsy. Appropriate patient selection is keystone in achieving sustained benefits in functionality and quality of life.
选择性脊神经后根切断术（SDR）有助于改善多种中枢神经系统（CNS）病因引起的下肢痉挛，提高功能。关于SDR的现有文献广泛讨论了其在脑瘫（CP）相关痉挛管理中的应用。对于非CP相关痉挛的儿科患者，在SDR患者选择的实用性和指导方面存在空白。
对从Medline和Embase数据库中识别出的描述儿科患者SDR结果的研究进行系统评价。纳入1970年1月至2023年8月期间的出版物。使用了“选择性脊神经后根切断术”“选择性后根切断术”和“痉挛”等搜索词的组合。纳入具有痉挛、行走、手术变量和随访结果等临床数据的儿科患者研究。详细审查了包括非脑瘫作为主要诊断患者的文章，以了解干预后的结果。
共识别出114篇出版物，其中11篇符合纳入标准，共涉及127例患者。痉挛最常见的非CP病因包括遗传性痉挛性截瘫（27.8%，n = 34）、先天性综合征（n = 7）和脊髓损伤（21.9%，n = 6）。与基线相比，非CP相关病因的SDR在大多数患者中显示肌张力正常化（93%，45例患者中的43例），并且在相当比例的患者中行走能力得到改善（49.2%，118例患者中的58例）。
这项关于儿科患者SDR的系统评价显示，在选定的非脑瘫患者中，痉挛得到有效控制，行走功能得到改善。合适的患者选择是在功能和生活质量方面实现持续益处的关键。
